Academic medicine : journal of the Association of American Medical Colleges
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Many forces, including the influential report of Abraham Flexner, acted to reform medical education in the early 20th century. Most physicians were not prepared to adopt recent advances in health care due to their poor medical training. This deficit was recognized in the 20 years before Flexner's report by several organizations, including the Illinois State Board of Health, the American Medical Association, and the Association of American Medical Colleges. ⋯ The actions of state medical licensing boards to deny recognition to poor schools sealed their fate. The remaining schools had higher entrance requirements, longer terms, and better resources. The author describes key factors that contributed to the success of the changes recommended by Flexner and others, and then posits why Flexner is still remembered.
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To systematically review published quality improvement (QI) and patient safety (PS) curricula for medical students and/or residents to (1) determine educational content and teaching methods, (2) assess learning outcomes achieved, and (3) identify factors promoting or hindering curricular implementation. ⋯ QI and PS curricula that target trainees usually improve learners' knowledge and frequently result in changes in clinical processes. However, successfully implementing such curricula requires attention to a number of learner, faculty, and organizational factors.
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Comment
Commentary: watching closely at a distance: key tensions in supervising resident physicians.
Graded responsibility and autonomy are integral features of medical education. High-quality patient care is paramount and is the ultimate responsibility of the attending physician. In the training setting, the teaching attending holds quality of care constant while balancing the amount of supervision and autonomy he or she gives the learner. ⋯ They defined gaps between when attending faculty feel residents are ready to perform a particular EPA, when the residents feel ready, and when the residents actually perform it. The tension between the imperative to ensure quality care and the competing imperative to grant graded autonomy can be described as "watching closely at a distance." The details of who should watch whom, when and what to watch, and how and how much to watch are all key issues for faculty and residents. Sterkenburg and colleagues provide a framework for further investigation (e.g., discerning the ideal level of supervision, developing a gold standard for assessing EPAs) into these critical medical education challenges.
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Randomized Controlled Trial
Simulation training in central venous catheter insertion: improved performance in clinical practice.
To determine whether simulation training of ultrasound (US)-guided central venous catheter (CVC) insertion skills on a partial task trainer improves cannulation and insertion success rates in clinical practice. ⋯ Simulation training was associated with improved in-hospital performance of CVC insertion. Procedural simulation was associated with improved residents' skills and was more effective than traditional training.
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Meta Analysis
A meta-analysis of studies of publication misrepresentation by applicants to residency and fellowship programs.
Many studies from various fields of medicine about the accuracy of residency and fellowship applications have reported disturbing percentages of candidates with publication misrepresentation on their applications. However, other similar studies have found much lower percentages. No evaluation of these types of studies is currently available to explain this disparity. Therefore, this study evaluated the wide range of percentages of applicants with publication misrepresentation reported in the literature. ⋯ The variance in study results of misrepresentation decreases when uniform inclusion criteria are applied. Caution must be used in directly comparing the results of these studies as originally reported. Program directors should be aware that self-promotion in the authorship list is a common form of misrepresentation.